ABSTRACT
@#Objective To monitor surgical quality and analyze learning curve of minimally invasive totally thoracoscopic cardiac surgery. Methods We retrospectively analyzed the clinical data of 150 consecutive patients who underwent minimally invasive totally thoracoscopic cardiac surgery in the Guangdong General Hospital between January 2013 and December 2015. There were 60 males and 90 females at age of 43.1 years. There were 60 patients with atrial or ventricular septal defect repair, 12 patients with cardiac tumor resection, 53 patients with mitral valve replacement and 25 patients with mitral valve repair. According to the surgical sequence, all the patients were divided into 3 groups including a group A, group B, and group C with 50 patients in each group (every 10 patients as a sequence, every 5 sequence as a group). Surgical outcomes were compared among the 3 groups, and surgical quality was analyzed with descriptive statistics. Results Surgical failure rate was 6.7% (10/150). There was no in-hospital mortality. Aortic cross-clamp time, cardiopulmonary bypass time and duration of mechanical ventilation, duration of ICU stay, duration of hospital stays of the group C were significantly shorter than those of the group A and group B. Analysis showed a significant learning curve effect in totally thoracoscopic cardiac surgery. When surgical cases reached about 100 cases, cardiopulmonary bypass and aortic cross-clamp time was shorter than the average value stably. Conclusion Totally thoracoscopic cardiac surgery is safe and reliable. For the beginners, it needs about 100 patients of surgery to master the totally thoracoscopic cardiac surgery.
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@#Objective To evaluate the efficacy of a combination of beating-heart minimally invasive approach and leaflets augmentation technique treating severe tricuspid regurgitation (TR) after cardiac surgery. Methods From January 2015 to August 2017, patients undergoing reoperative tricuspid valve repair (TVP) with minimally invasive approach and leaflets augmentation were enrolled. Cardiopulmonary bypass (CPB) was established via femoral vessels and the procedures were performed on beating heart with normothermic CPB. A bovine pericardial patch was sutured to leaflets to augment the native anterior and posterior leaflets. Other repair techniques, such as ring implantation and leaflet mobilization, were also applied as needed. Results A total of 28 patients (mean age 55.6±10.1 years, 5 males, 23 females) were enrolled. One patient was converted to median sternotomy due to pleural cavity adhesion. Twenty-seven patients underwent totally endoscopic TVP with leaflets augmentation. No patients was transferred to tricuspid valve replacement. Two patients died in hospital. All patients were followed up for 7.4±5.0 months and there was no late death and reoperation. Regurgitation area was converted from 20.7±10.1 cm2 to 3.3±3.3 cm2 after TVP according to the latest echocardiography (P<0.001). Conclusion Minimally TVP with leaflets augmentation is effective in treating severe isolated TR after primary cardiac surgery. It can significantly increase success rate of tricuspid valvuloplasty and decrease the surgical trauma.
ABSTRACT
@#Objective To evaluate the outcomes and summarize the clinical experience of totally endoscopic mitral valve repair with artificial chordae implantation. Methods From May 2013 to June 2016, 71 patients with mitral valve insufficiency were admitted to our hospital who underwent totally endoscopic mitral valve repair with artificial chordae implantation. There were 47 males and 24 females with the age of 46.0±14.4 years ranging from 13-78 years. The pathogenesis included degenerative valvular diseases in 63 patients, congenital valvular diseases in 4, infectious endocarditis in 2, rheumatic disease in 1 and cardiomyopathy in 1. Prolapse of anterior, posterior, or both leaflets was present in 26 (36.6%), 19 (26.8%), and 25 (35.2%) patients, respectively; one patient (1.4%) presented valve annulus enlargement and thirteen were associated with commissure lesion. The mitral regurgitation area ranged from 4.2 to 26.3 cm2 (mean, 12.2±5.6 cm2). All the procedures were performed by total endoscopy under cardiac arrest. 5-0 Gore-tex sutures were used as the material of artificial chordae which was implanted one by one. Results There was no in-hospital death. One patient was transferred to mitral valve replacement, and one median sternotomy due to bleeding. The mean cardiopulmonary bypass time was 156.0±31.6 min and aortic cross-clamp time 110.0±20.1 min. We finally had 39 isolated mitral valve repair, 28 mitral valve repair combined tricuspid valve repair, 3 mitral valve repair combined atrial septal defect closure, and 1 mitral valve repair combined correction of partial anomalous pulmonary vein connection. Each patient was implanted artificial chordae of 2.5±1.7 (ranging from 1 to 7), and 65 patients received mitral annulus (full ring). The intraoperative transoesophageal echocardiography found no mitral regurgitation in 44 patients, the area of mitral regurgitation was 0-2 cm2 in 24, and 3 patients with mitral regurgitation>2 cm2 experienced serious systolic anterior motion. Of the 3 patients with systolic anterior motion (SAM), one transferred to mitral valve replacement, one underwent mitral re-repair, and one took conservative treatment. The mean follow-up was 12.7±10.5 months (range: 1 to 36 months), while 2 patients were lost to follow up with the follow-up rate of 97.2%. Recurrent severe regurgitation occured in 3 patients, moderate in 5, mild or trivial in 27 and no regurgitation in 36. During the follow-up, 1 patient died of myocardiopathy-induced heart failure post discharge, 1 suffered from cerebral infarction, and no patient underwent reoperation. Conclusion The totally endoscopic surgical treatment of mitral valvuloplasty with artificial chordae is reliable for patients with mitral valve prolapse, which provides favorable clinical efficacy and outcomes. The difficulty lies in how to determine the appropriate length of the chordae and keep the stability of length.